Suzannah Biernoff writes:
Isabelle Dinoire, the world’s first face transplant recipient, died last April, 11 years after the history-making, controversial surgery that turned her into a medical celebrity. Dinoire was no stranger to the international news media – Getty Images alone has several pages devoted to her on their website – and her death was widely reported around the world. At the time, I was settling into the British Library to begin a new piece of research, as it happens, on the history of the face transplant. Dinoire’s story had been in the back of my mind for a while: I had met two of her surgeons, Bernard Devauchelle and Sylvie Testelin (Institut Faire Faces, Amiens), through the UK/French 1914FACES2014 project led by David Houston Jones at the University of Exeter. Testelin had spoken eloquently about the tactile aesthetics of surgery in a way that reminded me of an artist describing the pleasure of making art. Isabelle’s death, at the age of 49, was tragic, but not completely unexpected: developing cancer is just one of the serious risks of long-term anti-rejection treatment.
The psychological and ethical implications of this new form of reconstructive surgery have been extensively debated since 2004, when the American Journal of Bioethics published a special issue on the subject. But face transplantation existed as an idea long before it became a medical possibility, and the media coverage of Dinoire’s surgery was shaped by this cultural history. As someone who works a lot with visual sources – media and medical representations as well as art – I was particularly interested in looking at the visual culture of face transplantation. There are images of facial reconstruction from ancient India (the Sushruta Samhita, composed in around 600 BCE, contains a picture of a forehead graft and surgical instruments), and the idea of face transplantation is often traced back to the sixteenth-century Italian surgeon and maker of noses Gaspare Tagliacozzi (1545-99), but it is not until the middle of the twentieth century that we find face transplantation imagined in graphic detail.
So the story I decided to tell was not about Isabelle Dinoire or the long history of plastic surgery, but about a French horror movie with Surrealist undercurrents and a belated cult following. Georges Franju’s Les Yeux Sans Visage (Eyes Without a Face) was released in 1960. A dubbed American version was distributed as The Horror Chamber of Dr. Faustus a few years later. Pierre Brasseur plays Dr Génessier, a renowned surgeon whose daughter Christiane (Edith Scob) has been tragically disfigured in a car accident caused by her father. Aided by his devoted assistant Louise (Alida Valli) the professor performs a series of experimental ‘heterografts’ in a secret operating theatre in his basement, using the faces of kidnapped young women to try and restore his daughter’s appearance.
The American film critic Pauline Kael recalled seeing the film in 1963 in a Saturday night double-horror bill at a cinema on Market Street in San Francisco:
The theatre, which holds 2646, was so crowded I had trouble finding a seat. Even dubbed, Eyes Without a Face … is austere and elegant … It’s a symbolist attack on science and the ethics of medicine. … Even though I thought its intellectual pretensions silly, I couldn’t shake off the exquisite, dread images.
But the audience seemed to be reacting to a different movie. They were so noisy the dialogue was inaudible; they talked until the screen gave promise of bloody ghastliness. Then the chatter subsided to rise again in noisy approval of the gory scenes. When a girl in the film seemed about to be mutilated, a young man behind me jumped up and down and shouted encouragement. “Somebody’s going to get it,” he sang out gleefully. The audience, which was, I’d judge, predominantly between 15 and 25, and at least a third feminine, was … pleased and excited by the most revolting and obsessive images (ref. 1, pp. 7-8).
Franju’s film sits uneasily within the academic history of plastic surgery, but as a cultural text it can tell us a lot about the stigma of disfigurement and the modern ‘surgical imaginary,’ to borrow Susan Lederer’s useful term. As Lederer points out in the introduction to Flesh and Blood: Organ Transplantation and Blood Transfusion in Twentieth-Century America, ‘the body and its parts – organs, tissues, cells, and fluids – possess not just medical and surgical significance, but complex political and cultural meanings as well’ (ref. 2, p. ix).
When I started looking for fictional face transplants, I thought identity would be the recurring theme. But even John Woo’s 1997 Hollywood action thriller Face/Off – the best-known example of face transplantation on film – isn’t really about identity transfer or loss of self. The characters played by John Travolta and Nicholas Cage swap faces, mannerisms and voices (thanks to some clever FBI technology), but beneath the skin their personalities and moral compasses remain fixed. This is face transplantation as extreme makeover – an idea echoed in some of the early newspaper reports of Dinoire’s surgery. Eyes Without A Face belongs to a different cultural moment, in which Génessier’s experimental heterografts are portrayed as a desperate and misguided scientific response to the social ‘death’ entailed by disfigurement.
For me, the most disturbing scenes in the film don’t take place in Génessier’s creepy operating theatre. What really gets me is the image of Christiane in her perfectly white mask and white silk taffeta robe, like a fragile and precious porcelain doll (in one scene she stands beside a framed portrait of a child with just such a doll). When she moves noiselessly through the house her feet barely seem to touch the ground. Christiane’s mask is not a portrait like the meticulously painted masks made for disfigured First World War servicemen by Francis Derwent Wood and Anna Coleman Ladd. Portraits are supposed to make the absent present. Christiane’s mask is an absence. And beneath it, we are told, is ‘an open wound’ – a wound we glimpse only once, through the eyes of one of Génessier’s victims before she goes under the knife.
Christiane herself admits that her mask frightens her more than the sight of her face. What fuels Génessier’s obsessive experimentation – and drives the film’s plot – is the conviction that disfigurement equals facelessness. This is an idea with a history. It is also an idea that has social and medical consequences. In Europe it is a concept that takes shape in response to the horrors of the First World War, and in particular the fear of facial mutilation. In Franju’s unsettling 1951 documentary Hȏtel des Invalides – a film that chronicles the ghosts of wars past – there is a lingering frontal shot of a disfigured veteran. Images like this – and the idea of disfigurement as a kind of death – were part of the post-WWI medical imaginary and clearly still potent in the 1950s.
‘Face transplant “made me human again”’ is the headline that appeared in The Times in July 2007 (ref. 3). Dinoire’s description of her ‘rebirth’ as a human being in an interview with Le Monde (the source for The Times feature) is both moving and concerning. It suggests that the history of the face transplant encompasses a constellation of assumptions that go beyond the cost-benefit analyses presented in the medical literature; assumptions about what it is to be human that urgently need challenging.
- Pauline Kael, I Lost It at the Movies: Film Writings 1954-1965 (New York: Marion Boyars, 1994 )
- Susan E. Lederer, Flesh and Blood: Organ Transplantation and Blood Transfusion in Twentieth-Century America (Oxford: Oxford University Press, 2008).
- Charles Bremner, ‘Face transplant “made me human again,”’ The Times, 7 July 2007, p. 37.
Suzannah Biernoff’s forthcoming article is titled ‘Theatres of surgery: the cultural pre-history of the face transplant.’ Her book Portraits of Violence: War and the Aesthetics of Disfigurement will be out in May.